Patient registration is an essential step in the emergency department (ED) workflow—it is required to initiate EHR documentation and impacts patient safety. Correctly identifying patients during registration is critical, as caregivers use historical data in the EHR to make treatment decisions.
Mission Health, as part of its ongoing performance improvement work, discovered that its registration process was lengthy—patients were waiting in line for as long as 15 minutes to be checked into the ED to receive treatment.
To improve its registration process, Mission implemented a quick registration process (e.g., asking fewer questions upon patient presentation at the ED) based on frontline staff feedback that, in a little over one year, dramatically reduced delays in ED patient care:

70 percent relative reduction in the time to complete registration, with current performance under one minute.
33 percent relative improvement in time from patient arrival to triage start time.
24 percent relative reduction in median length of stay (LOS) for discharged patients, 15 percent relative reduction for admitted patients, and 42 percent relative reduction in median LOS for behavioral health patients.

Overcrowding in the emergency department (ED) has been associated with increased inpatient mortality, increased length of stay (LOS), and increased costs for admitted patients. ED wait times and left without being seen (LWBS) rates—patients who present to the ED but leave before receiving a medical evaluation—are indicators of overcrowding.
Mission Health needed to address overcrowding in its ED. The community hospital system confirmed overcrowding when it determined that approximately 4,000 patients were leaving its ED each year without being seen.
Mission implemented an improvement process to address ED overcrowding. The hospital leveraged its analytics platform to develop an ED analytics application that provided actionable, timely ED performance data to focus improvement efforts on four areas: staffing patterns, registration, triage assessment by the registered nurse (RN), and early access to a qualified medical provider.
Mission achieved significant ED performance improvements:

89 percent relative reduction in LWBS rate, with current performance at 0.4 percent.
85 percent relative reduction in percentage of patients who left before treatment complete, with current performance at 0.58 percent.
75 percent relative reduction in median door to assessment by a qualified provider, with current performance under 15 minutes.

Health systems can directly impact the quality of emergency department (ED) care by reducing the time patients wait between arrival and seeing a qualified medical professional. Long ED wait times can reduce patient satisfaction and put patients at risk.
Mission Health determined that patients in its ED often waited more than 50 minutes to receive qualified medical care. To decrease this wait time, the hospital system sought to improve its ED patient flow. Using data-driven insights provided by use of its analytics platform, Mission could visualize each portion of the ED patient flow, enabling the improvement team to identify and respond to opportunities for process improvement.
Using this strategy, Mission achieved the following:

89 percent relative reduction in the rate of patients who left without being seen (LWBS), resulting in the current performance of 0.4 percent.
29 percent relative reduction in the time from discharge order to ED departure time.
24 percent relative reduction in the median length of stay (LOS) for patients who are discharged.

Since 2004, the US healthcare system has annually ranked last relative to 10 other developed nations in quality, access, efficiency, equity, and health outcomes. In an effort to improve the quality of care and patient outcomes in the U.S., the Center for Medicare and Medicaid (CMS) launched a series of quality incentive programs designed to generate a shift from volume to value-based reimbursement. The health insurance industry soon followed their lead, and started writing contracts with hospitals in which a percentage of payment was based on performance on selected quality metrics.
Faced with the challenge of reporting on numerous incentive programs with differing expectations, Mission Health leveraged their enterprise data warehouse to aggregate the data needed to track the quality measures. With millions of dollars on the line with one particular payer, Mission developed an analytics application to monitor performance on the metrics in that contract. The application was used to analyze whether performance feedback and workflow changes would lead to improved performance on the metrics, thus ensuring that they would maximize reimbursement, while improving care for patients.
Results:

Achieved 100 percent of all at risk dollars.
100 percent of the ambulatory metric targets were exceeded, some by as much as 19 percent.
All five hospitals exceeded targets for 80 percent or more of their inpatient metrics.

Tracing its roots back nearly 120 years, Mission Health has a vision to provide world-class care to western North Carolina and beyond—even as the entire healthcare profession experiences a disruptive upheaval. Mission determined to meet these external changes by making a big change of its own: embracing a culture of continuous improvement.
Mission subsequently engaged physicians and other clinicians to increase process improvement skills, while expanding access to meaningful data via an analytics platform from Health Catalyst.
Results:

With the advent of analytics, hospitals have new access to high quality, reliable data. In turn, this can fuel any number of outcomes improvement projects, but hospitals have finite resources to expend on these initiatives. A process is needed to identify which ones will deliver the highest value and best align with the hospital’s overarching priorities.
To balance the demand for analytics support of improvement projects Mission Health designed a prioritization tool that has helped them identify the right projects to approve–while keeping stakeholders more engaged than ever in improving outcomes for patients.
To date, 80 percent of 55 approved projects have met or exceeded their initial targets. Actual realized targets include:

The U.S. healthcare system is the most expensive in the world, but data consistently shows the U.S. underperforming relative to other countries on most dimensions of performance. The Centers for Medicare & Medicaid Services’ (CMS’s) accountable care organization (ACO) model is aimed at addressing that issue by offering financial incentives for providers to improve the health of populations and reduce costs through greater efficiencies and a focus on preventive care.
Mission Health formed a Medicare Shared Savings Program (MSSP) ACO called Mission Health Partners (MHP), which is responsible for 40,000 patient lives. MHP knew that its manual approach to data collection and reporting would not be sufficient for the required ACO quality metrics. By leveraging a previously implemented enterprise data warehouse platform and implementing an ACO MSSP analytics application, MHP was able to automate the processes of data-gathering and analysis and align the data with ACO quality reporting measures. The visibility and transparency of near real-time, online performance data coupled with focused process improvement has resulted in subsequent improvement in all 33 of the ACO performance metrics. Specifically, improvements have included:

9.6 percent increase in compliance over all reported ACO metrics, with 23,000 more patients receiving recommended treatment or screenings.
98.9 percent of eligible patients received screenings for clinical depression and follow up.
40 percent increase in number of patients receiving any cancer screening; 46 percent improvement in the number of patients receiving colorectal cancer screening.
456 percent increase in the number of patients getting fall risk screening.

The consequences of poor-quality surgical care are significant for both hospitals and patients. Consider the following: One in four patients having a colon re-section is readmitted within 90 days, costing U.S. healthcare approximately $300 million a year and negatively affecting the lives of tens of thousands of patients and their families.
In 2013, Mission Health, North Carolina’s sixth-largest health system, identified opportunities to improve clinical outcomes for its bowel surgery patients. With a vision of achieving the best outcome for each patient, Mission set goals to reduce length of stay (LOS), decrease readmissions, and reduce surgical site infections (SSIs) for its bowel surgery patients.
Mission recognized that care process models (CPMs) were key to making it easier for clinicians to deliver the best care to patients by doing the right thing consistently. The health system therefore organized a multidisciplinary improvement team charged with developing and implementing an evidence-based CPM for bowel surgery. In support of this effort, Mission leveraged technology and analytics to encourage clinician adoption of the CPM and to deliver performance insights.
Through these efforts, Mission has achieved impressive improvements in bowel surgery care:

Advancing women’s health is a key part of the nation’s healthcare quality improvement and population health management agenda. Mission Health has embarked on a journey to standardize its best practices and develop a more systematic method for collecting and analyzing data related to perinatal care. With an EDW serving as its analytics platform, and a newly implemented clinical improvement model, Mission is able to monitor performance on several evidence-based practices designed to improve maternal and newborn care. Learn how they have sustained a zero elective delivery rate, and how they have reduced the time they spend manually collecting data and calculating rates.

Sepsis, a serious complication that strikes quickly and is often fatal, is the single most expensive condition to treat in the hospital, in part because of the longer than average stay. To reduce sepsis mortality rates, which are between 20 and 50 percent, many hospitals have established evidence based bundles comprised of antibiotic administration, lactate level monitoring and other elements of care. However, without analytics, hospitals rely on manual processes to track sepsis rates and bundle compliance. Learn how Mission Health has streamlined surveillance by 75% while experiencing a 2.6% reduction in sepsis mortality rates and an 18% reduction in length of hospital stay.

Mission Health in North Carolina has always been dedicated to expanding access to care. To preserve this commitment in an era of declining reimbursement rates, Mission needed better access to data for quick and flexible decision-making. As at most hospitals, operating rooms are Mission’s biggest revenue generator, but they also represent a significant cost center. So, leveraging their new analytics capabilities to drive operational improvements across their system of operating rooms was a strategic opportunity. Mission now has improved ability to drive care and operational improvements with integrated data and analytic tools like their OR Dashboard—resulting in dramatic improvements including a 20% increase in first-case on-time surgical starts.